| NPI | 1265656748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.006105) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 34.006105) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-07-11 |