NPI | 1679803290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.099854) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27524) |
Enumeration Date | 2010-01-04 |
Last Update Date | 2022-01-25 |