| NPI | 1932162856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 16453) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 16453) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-04-06 |