| NPI | 1750398277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 29744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35068687) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-02-22 |