| NPI | 1669471561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 19118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35073683) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2011-06-15 |