| NPI | 1457369019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A99116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35085972) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-11-30 |