| NPI | 1003081241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD29054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57012374) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2020-11-16 |