| NPI | 1700890597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60024498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.082702) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-12-10 |