| NPI | 1598749814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34010077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102049850) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2017-02-17 |