| NPI | 1972640696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34. 003137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1101) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2025-06-04 |