| NPI | 1528212602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 62866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.092477) |
| Enumeration Date | 2008-11-16 |
| Last Update Date | 2020-10-15 |