| NPI | 1669419727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35038148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 39131) |
| 207Q00000X Family Medicine (Licence: MI 0924297) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2007-07-08 |