| NPI | 1639281090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 81726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35078207) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-08-31 |