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 |