| NPI | 1093291148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.014808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018024675) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2022-01-25 |