NPI | 1922147818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-064194) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301075438) |
Enumeration Date | 2007-02-06 |
Last Update Date | 2023-08-10 |