| NPI | 1053368019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 007761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02726) |
| 207Q00000X Family Medicine (Licence: WV 3072) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2017-10-13 |