| NPI | 1386911626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60449505) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58004260) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2022-08-30 |