| NPI | 1699916528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 79934) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 010638) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2025-10-31 |