| 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 |