| NPI | 1780652792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35080468W) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 70831) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-04-30 |