| NPI | 1336381326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35093488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 093488) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2020-11-17 |