| NPI | 1699209692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35146171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 73274) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2022-10-21 |