| NPI | 1437106515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-00565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35075175-V) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2013-07-18 |