| NPI | 1174671754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A112789) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35094718) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-12-15 |