| NPI | 1982199188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301505716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.142991) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2024-10-04 |