| NPI | 1114131778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.141306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088287) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-03-25 |