| NPI | 1811988256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102210035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34004170P) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2026-04-28 |