| NPI | 1225031768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-06-4727-T) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 31621) |
| 207Q00000X Family Medicine (Licence: AK 7690) | |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2013-11-21 |