| 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 |