| NPI | 1700046596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57010891) |
| 207Q00000X Family Medicine (Licence: AZ 40749) | |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2017-04-06 |