| NPI | 1174905624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3360) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2023-07-14 |