| NPI | 1518286921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 0477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 1090) |
| 207Q00000X Family Medicine (Licence: OH 1511) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2010-05-25 |