| NPI | 1386646214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101241224) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-051517) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2007-09-10 |