| NPI | 1043256423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 38038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35086408) |
| 207Q00000X Family Medicine (Licence: CA A86703) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2025-10-22 |