NPI | 1861631947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 47349) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35093557) |
208D00000X General Practice (Licence: KY 47349) | |
Enumeration Date | 2009-02-12 |
Last Update Date | 2023-11-27 |