| NPI | 1679998975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018009700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.011922) |
| Enumeration Date | 2014-02-23 |
| Last Update Date | 2023-06-28 |