| NPI | 1205169760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-050910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC DO034845) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2021-02-24 |