| NPI | 1972573533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-7361-R) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-01-14 |