| NPI | 1073550786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35079659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 36543) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2021-03-09 |