| NPI | 1669667598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.089537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35089537) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2012-11-28 |