| NPI | 1679576441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.004022) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-10-16 |