| NPI | 1851334072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-00-7988-D) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007998) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-03-24 |