| NPI | 1003511510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 5006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.018454) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2026-07-08 |