| NPI | 1023076338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.057043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35057043K) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2014-10-08 |