| NPI | 1366754897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.049623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME60509) |
| 207Q00000X Family Medicine (Licence: IN 01034608A) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2010-07-13 |