| NPI | 1043604135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301107643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.138408) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2023-09-01 |