| 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 |