| NPI | 1154680924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.127085) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OH 35127085) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2026-05-06 |