| NPI | 1972999035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME153136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.133936) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2022-04-08 |