| NPI | 1386389013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.018158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151015526) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2025-09-08 |