| NPI | 1457454738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C54483) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35088053) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2024-02-23 |