NPI | 1124008917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1666) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.007367) |
Enumeration Date | 2006-01-19 |
Last Update Date | 2016-03-24 |