| NPI | 1861499121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34002859B) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2014-06-25 |