| NPI | 1043264716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34004028) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-04-29 |