| NPI | 1871657544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 26860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35 . 086208) |
| 207Q00000X Family Medicine (Licence: IN 01060602A) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |