| NPI | 1194745612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 90620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 28044) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2011-09-12 |