| NPI | 1700955051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-005089) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-03-07 |