| NPI | 1043222896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35076823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 36326) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-01-27 |