| NPI | 1215977921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME ME1961) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-04-05 |