| NPI | 1235146119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 20164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 36724) |
| 207Q00000X Family Medicine (Licence: OH 35079995) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2024-04-26 |