| NPI | 1245444074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 22530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.091875) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-07-16 |