| NPI | 1376790584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60268913) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH FB0673815-198) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2016-12-30 |