| NPI | 1811938038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A143019) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-07-6137-W) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2018-06-05 |