| NPI | 1013987759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 011418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO785) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-04-24 |