| NPI | 1538320833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.097411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL31034) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2022-04-18 |