| NPI | 1174744072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A98465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.088438) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2023-02-09 |