| NPI | 1275546509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.010644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3791) |
| 207Q00000X Family Medicine (Licence: FL OS 8291) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2012-12-31 |