| NPI | 1235387416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 35.120134) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: KY TP891) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301093350) | |
| Enumeration Date | 2008-08-30 |
| Last Update Date | 2018-03-17 |