| NPI | 1245591056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 353147854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 34720) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2023-07-17 |