| NPI | 1033552344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME149021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.131766) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2025-06-12 |