| NPI | 1730335407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 66050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57-014665) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2022-10-04 |