| NPI | 1831152198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60744283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34004921) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2018-06-18 |