| NPI | 1356978456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101284925) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.149844) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-04-07 |