| NPI | 1457533846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 26930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.056242) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2013-01-11 |