| NPI | 1881631851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV NV-8288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-06-2966-) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2007-07-08 |