| NPI | 1629697370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.149555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301511050) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2024-03-18 |