| NPI | 1831358365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35121689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301095293) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2022-01-25 |