| NPI | 1033257118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.006224) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1991) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2024-08-15 |