| NPI | 1336183011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: OH 35.053776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35053776) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-05-23 |