| 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 |