| NPI | 1689737132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 0024138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35046610) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2019-07-30 |