| NPI | 1407891708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35054126) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD039456L) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2011-07-08 |