| NPI | 1063831618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35128647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.128647) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2025-09-02 |