| NPI | 1013176312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54556-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35097870) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2013-05-17 |