| NPI | 1235221508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35084170) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2016-09-12 |