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 |