| NPI | 1164731923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57642-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.120112) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2020-06-08 |