| NPI | 1093955346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 107951) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.012957) |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2015-03-26 |