| NPI | 1366068660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.152744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1015601) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-04-17 |