| NPI | 1336247667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0105192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007698K) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2026-06-18 |