| NPI | 1821068990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY C4607) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.006242) |
| 207P00000X Emergency Medicine (Licence: OH 34-00-6242) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2026-02-18 |