| NPI | 1891755021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: IA MD-48052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35067724) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-08-19 |