| NPI | 1447253208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 16285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.086160) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-01-13 |