| NPI | 1124094669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-01739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35072211) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2021-11-22 |