| NPI | 1235115270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34007833G) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1932) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2021-03-18 |