| NPI | 1134128093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101010072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34006599) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2023-11-27 |