| NPI | 1093789521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007934) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2021-11-18 |