| NPI | 1558866301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.141866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 238398) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2021-06-22 |