| NPI | 1235184458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-00-5520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 15255) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-08-07 |