| NPI | 1023000262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.135297) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301074352) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2019-02-06 |