| NPI | 1881715563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2016-0070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35064260) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2023-10-18 |