| NPI | 1407084098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 144412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.099023) |
| 207Q00000X Family Medicine (Licence: SC MD31884) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2023-03-07 |