| NPI | 1043261530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.063029) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 40446) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-04-13 |