| NPI | 1326346164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 332740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35122354) |
| 207Q00000X Family Medicine (Licence: OH training certificate) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2022-08-08 |