| NPI | 1235526211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 92583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.133527) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2023-01-18 |