| 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 | 2026-06-22 |