| NPI | 1962500876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.076195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 21386) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-04-21 |