| NPI | 1427390905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 30825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35126926) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2022-04-27 |