| NPI | 1942213285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.127498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088869) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2018-09-10 |