| NPI | 1922617950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-044916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 37654) |
| 207Q00000X Family Medicine (Licence: FL ME85403) | |
| 207Q00000X Family Medicine (Licence: LA MD.207574) | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-07-27 |