| NPI | 1124693809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 72116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.251493) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-07-25 |