| NPI | 1114453842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.148377) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-09-20 |