| NPI | 1447201256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35078036K) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00037575) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-12-21 |