| NPI | 1184679334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.061212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-06-1212P) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-06-20 |