| NPI | 1396073037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012025722) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.017025) |
| 207Q00000X Family Medicine (Licence: MO 2010019777) | |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2013-08-20 |