| NPI | 1760863369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO215116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012782) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-04-27 |