| NPI | 1801855853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 087031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G49469) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2011-09-02 |