| NPI | 1861013591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.146705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.249636) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2023-07-16 |