| NPI | 1780804401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD165025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35092730) |
| 207Q00000X Family Medicine (Licence: KY 43003) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-03-07 |