| NPI | 1306308986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.148173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 176591) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-01-25 |