| NPI | 1952543993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-125996) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D74469) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2025-11-07 |