| NPI | 1477541332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS012529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34008584) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-05-10 |