NPI | 1396783080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME149672) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.077375) |
207Q00000X Family Medicine (Licence: OH 35-07-7375-W) | |
Enumeration Date | 2006-06-03 |
Last Update Date | 2022-01-14 |