| NPI | 1124315601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A141213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35. 122788) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2016-04-28 |