| NPI | 1366533390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 034009030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03046) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-04-08 |