| NPI | 1700455474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.253399) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021022587) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-11-04 |