| NPI | 1255310405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101244392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35043280) |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2009-03-30 |