| NPI | 1235129404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.042368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 42368) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-03-18 |