| NPI | 1316941156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35122033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101052226) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2013-09-11 |