| NPI | 1124330774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34011166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03490) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2025-01-13 |