| NPI | 1063723492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME170153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.122048) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2025-01-17 |