| NPI | 1588612006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-00926) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34008666) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2022-10-17 |