| NPI | 1639499577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35120619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 39010) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2022-07-21 |