| NPI | 1407376239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.138026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 53851) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-05-22 |