| NPI | 1447994405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.017405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 12.345678) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2025-06-30 |