| NPI | 1508887852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C144985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35087799) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2024-04-11 |