| NPI | 1518923853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 27021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35058805V) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-04-30 |