| NPI | 1992993638 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.094193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57-008773) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2020-12-22 |