| NPI | 1477528339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 25188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35052673C) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2020-08-27 |