| NPI | 1710936505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-008594) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 01202202039) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2020-11-06 |