| NPI | 1275206088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.018085) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5151015158) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2025-07-16 |