| NPI | 1619380557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.130676) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.130676) |
| 207Q00000X Family Medicine (Licence: TX BP10049153) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-09-08 |