| NPI | 1730366378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 73284) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35095677) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2023-03-02 |