| NPI | 1033322698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301094144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57011635) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2015-04-26 |