| NPI | 1013151265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C181332) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.078849) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2023-08-23 |