| NPI | 1467915397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.016076) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-02359) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2022-09-12 |