| NPI | 1891779047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 19909) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 19909) |
| 207P00000X Emergency Medicine (Licence: WV 19909) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2010-04-19 |