| NPI | 1780785899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-088201) |
| 207Q00000X Family Medicine (Licence: IN 01064022A) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-05-03 |