NPI | 1255372090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-00416) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35075912) |
Enumeration Date | 2006-06-10 |
Last Update Date | 2023-07-27 |