| 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 | 2025-05-23 |