| NPI | 1467569947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME141580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35C.000244) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-08-19 |