| NPI | 1730323387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.137462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301101213) |
| 207Q00000X Family Medicine (Licence: PA MD462572) | |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2021-12-27 |