| NPI | 1801885934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 060615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34003002) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2018-06-16 |