| 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 |