| NPI | 1306820063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.094212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 34347) |
| 207Q00000X Family Medicine (Licence: MA 228350) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2013-05-23 |