| NPI | 1710919642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9900105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 9900105) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-08-01 |