| NPI | 1306840012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-30685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35072819) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-02-18 |