| NPI | 1417933508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.006811) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-06-20 |