| NPI | 1033255112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 8187) |
| 207Q00000X Family Medicine (Licence: OH 35.099715) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2021-11-18 |