| NPI | 1902833296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 31649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35072610) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2019-07-22 |