| NPI | 1427198787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 231577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH BB5202786150) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-11-18 |