| NPI | 1003992546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35050485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 12712) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2021-01-13 |