| NPI | 1538145925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 4485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101010477) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2019-06-06 |