| NPI | 1134240898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.092413) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 2789482-m03-027) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2017-05-03 |