| NPI | 1003811472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 15792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35075378) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2025-04-29 |