| NPI | 1659504314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O0680) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 58003156) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2019-01-09 |