| NPI | 1265531859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35074996A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.074996A) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-09-26 |