| NPI | 1255380648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-08-5485) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2014-05-07 |