| NPI | 1528375227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0053550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.121684) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2021-06-14 |