| NPI | 1932506730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34013187) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.006052) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2024-04-17 |