| NPI | 1073547097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.009487) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2014-08-26 |