| NPI | 1538571468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-03805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34C.000021) |
| 207Q00000X Family Medicine (Licence: MN 61680) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2026-04-14 |