| NPI | 1902809007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-3355-W) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-10-21 |