| NPI | 1477590636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-07-9271 S) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-14764) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-02-11 |