NPI | 1295095966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.256607) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 54.001213-P-RX) |
Enumeration Date | 2012-05-29 |
Last Update Date | 2024-03-29 |