NPI | 1699966291 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A114377) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.012883) |
Enumeration Date | 2007-08-07 |
Last Update Date | 2023-03-07 |