| NPI | 1316992662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.003545) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34003545A) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-11-28 |