| NPI | 1669683090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.120256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME100400) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-07-19 |