| NPI | 1669470258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.006774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02433) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2025-04-08 |