| NPI | 1285621318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS07678) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 340015002) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2011-09-30 |