| NPI | 1245296540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35057336P) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 29968) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2018-01-26 |