| NPI | 1306069075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-039492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 4211) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2009-08-05 |