| NPI | 1407859218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.007508) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2022-07-19 |