| NPI | 1235626318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.142796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH TK864943) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2021-08-31 |