| NPI | 1720656408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.152250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL17377) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2024-12-16 |