| NPI | 1730125766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012804) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2017-07-28 |