| NPI | 1053406686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-00328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 002717) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-11-11 |