| NPI | 1134623721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 75849-02) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.140164) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2021-09-28 |