| NPI | 1851396659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34007087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03040) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2013-02-05 |