| NPI | 1740247279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.047298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 33071) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-10-27 |