| NPI | 1760437883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.057132) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-11-10 |