| NPI | 1952927444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.148932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046671) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2023-08-07 |