| NPI | 1881676690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 18048) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: WV 18048) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: WV 18048) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-09-20 |