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 |