| NPI | 1427161405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C179494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-7004B) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-08-12 |