| NPI | 1225026479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 84824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-096641) |
| 207Q00000X Family Medicine (Licence: NC 200501084) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2021-02-22 |