| NPI | 1851882146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61215451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.030435) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2021-11-18 |