| NPI | 1275739575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.125287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2010-00527) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2022-01-25 |