| NPI | 1871541235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 18452) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-07-0544) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2026-02-05 |