| NPI | 1144293226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: FL ME0040204) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: OH 35049692R) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2007-07-08 |