| NPI | 1154361467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0063554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-065460) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-08-16 |