| NPI | 1184073850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.142804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5601009235) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2026-03-19 |