| NPI | 1841281094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M7892) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-004765-C) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2014-05-01 |