| NPI | 1790906634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 2923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.061305) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2009-05-19 |