| NPI | 1588066922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.134977) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R3242) |
| 207Q00000X Family Medicine (Licence: IN 01077614A) | |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2018-10-02 |