| NPI | 1427558873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.017116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS17753) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2024-07-11 |