| NPI | 1396779591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301107535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-000294) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-03-31 |