| NPI | 1548238017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.089215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP976) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2008-11-18 |