| NPI | 1306822457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.122335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 37022) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2019-10-22 |