| NPI | 1356322507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS008626L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-006416) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2014-07-14 |