| NPI | 1568509685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200200101) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.144519) |
| 207Q00000X Family Medicine (Licence: FL ME65017) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-05-13 |