| NPI | 1386893840 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 58002603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03306) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2023-01-06 |