| NPI | 1699730267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35075368T) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH OH35075368T) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-11-18 |