| NPI | 1659333482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82653-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-07-8064-P) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2023-09-11 |