| NPI | 1447468293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8488408-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.001871) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-10-21 |