| NPI | 1891444618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 35104) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WV 35104) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2026-08-28 |