| NPI | 1588616494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0017249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-08-3771) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-03-08 |