| NPI | 1407072861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 58-002193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 48943) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2010-07-21 |