| NPI | 1427285154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301093930) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.099865) |
| 207Q00000X Family Medicine (Licence: OH 35.099865) | |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2021-04-13 |