| NPI | 1730257445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 3503171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 05976) |
| 209800000X Legal Medicine (Licence: OH 3503171) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2023-03-07 |