| NPI | 1649709478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.015128) |
| 207Q00000X Family Medicine (Licence: MO 2022044426) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2023-10-17 |