| NPI | 1376075457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.145341) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2021-01416) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-08-10 |