| NPI | 1124008917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.007367) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2016-03-24 |