| NPI | 1366641573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301084543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.090527) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2011-10-20 |