| NPI | 1700845724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301116505) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.083400) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2019-06-05 |