| NPI | 1497735591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.008635) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2007-11-13 |