| NPI | 1972563997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: OH 35057308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-057308) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-10-30 |