| NPI | 1154373199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35122511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 26045) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-01-25 |