NPI | 1023037397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 202K00000X (Licence: OH 4358) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-4358W) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2012-01-19 |