| NPI | 1295788347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60224040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35086817) |
| 207Q00000X Family Medicine (Licence: SD 5885) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-01-06 |