| NPI | 1013101948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 238815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.011729) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2017-08-18 |