NPI | 1336686328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.150547) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101276978) |
Enumeration Date | 2017-01-27 |
Last Update Date | 2024-06-21 |