NPI | 1194943522 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2120) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012389) |
Enumeration Date | 2007-04-23 |
Last Update Date | 2016-12-27 |