| NPI | 1326253105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301091405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.088592) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-04-18 |