| NPI | 1255892766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301507391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.247314) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-05-03 |