| NPI | 1326043852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C159821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35050954B) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2019-04-04 |