| NPI | 1427363902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35126077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A113558) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2021-12-01 |