| NPI | 1962407254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-00404) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007261) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-10-25 |