| NPI | 1730230376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: OH 35.048491) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 35.048491) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2023-03-07 |