| NPI | 1952971608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 4099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV ED1024) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2024-11-15 |