| NPI | 1881135135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.139789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 53611) |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2022-10-21 |