| NPI | 1306872528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34006392) |
| 207Q00000X Family Medicine (Licence: KY 02853) | |
| 207Q00000X Family Medicine (Licence: IA DO-04444) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-04-30 |