| NPI | 1568718674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-00625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.011554) |
| 207Q00000X Family Medicine (Licence: NM A-1939-16) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2021-02-19 |