| NPI | 1821241431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME119394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-096907) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2023-02-02 |