| NPI | 1891774675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35077695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 077695) |
| 207R00000X Internal Medicine (Licence: OH 35.077695) | |
| 207P00000X Emergency Medicine (Licence: KY 35913) | |
| 207R00000X Internal Medicine (Licence: KY 35913) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-12-16 |