| NPI | 1306085220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.094959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R1591) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2022-01-25 |