| NPI | 1215901772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-05-7052) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: KY 40029) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2008-10-10 |