| NPI | 1891866737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.202789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35079430) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2026-04-20 |