| NPI | 1467551952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35077155D) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.077155D) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-09-26 |