| NPI | 1215129986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C138797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT189785) |
| 207Q00000X Family Medicine (Licence: IN 01069757A) | |
| 207Q00000X Family Medicine (Licence: OH 35.122125) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2016-09-13 |