| NPI | 1134229412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME111388) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35062914G) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-10-13 |