| NPI | 1871553198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35085944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 13204) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2011-07-06 |