| NPI | 1699033035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 35.122617) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.122617) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2018-03-17 |