| NPI | 1629484902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 80159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012118) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2023-10-23 |