| NPI | 1851398523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 49185-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.073508) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2012-06-08 |