| NPI | 1043259799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35085399-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 058692) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-11-07 |