| NPI | 1700856416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-00063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 008269) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-10-24 |