NPI | 1982045969 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2881) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV ED0339A) |
Enumeration Date | 2013-07-08 |
Last Update Date | 2023-08-16 |