| NPI | 1205065604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 68804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.099212) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2019-10-03 |