| NPI | 1396954293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2008006958) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.001957) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2014-09-24 |