| NPI | 1336107275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 073188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.077216) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2016-06-28 |