| NPI | 1215215520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301099280) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.124000) |
| 207Q00000X Family Medicine (Licence: OH 35.124000) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2023-10-24 |