| NPI | 1801862826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 33892) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35062108) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2010-02-05 |