| NPI | 1235319187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03364) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 58.002588) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2016-07-19 |