NPI | 1215427018 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-04561) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.030265) |
Enumeration Date | 2018-05-16 |
Last Update Date | 2024-06-05 |