| NPI | 1275952590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.145317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.145317) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-06-25 |