| NPI | 1154398493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.098674) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 18392) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2015-02-20 |