| NPI | 1205919909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200700782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.047427) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2015-03-31 |