| NPI | 1699033589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.127146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 61265-20) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2018-01-26 |