| NPI | 1831839539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101283706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.253484) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-08-21 |