| NPI | 1205814472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35057100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301055329) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2016-05-09 |