| NPI | 1073735098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 28353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57008429) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2011-09-23 |