| NPI | 1942394366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-07-1841) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-10-18 |