| NPI | 1487616751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-059687) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OH 35059687) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2013-04-22 |