| NPI | 1346564879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018034897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34010540) |
| 208VP0000X (Licence: MO 2018034897) | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2026-02-12 |