| NPI | 1912402769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.153651) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2021-00732) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-05-20 |