| NPI | 1104455575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL90005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.017400) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2024-10-10 |