| NPI | 1174505119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.058139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME81500) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2013-11-15 |