| NPI | 1023079456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WV 21327) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 21327) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: OH 35.122976) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2021-12-06 |