| NPI | 1689652158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2016016256) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35-065764) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2016-07-08 |