| NPI | 1336179704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A7399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34006696S) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-05-15 |