| NPI | 1932125762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.009139) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-09-15 |