| NPI | 1396905584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.011822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34011822) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2023-03-24 |