| NPI | 1326400979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.135858) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2021-08-10 |