| NPI | 1407835572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.137356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G63539) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-12-12 |