| NPI | 1306878699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D67273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.071421) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-07-07 |