| NPI | 1306951157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.138002) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 20876) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-12-16 |