| NPI | 1487699419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35077320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 36975) |
| 207Q00000X Family Medicine (Licence: WI 49924) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-07-18 |