| NPI | 1467566604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD18087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35077106B) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2012-04-16 |