| NPI | 1952593998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2187) |
| 207Q00000X Family Medicine (Licence: OH 34.010170) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2022-02-10 |