| NPI | 1649368986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60707386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35084662) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2017-01-10 |