| NPI | 1821217852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 46017) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.092484) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2019-03-04 |