| NPI | 1447471164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-088148) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 35-088148) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-11-03 |