| NPI | 1891748836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C130915) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.083971-I) |
| 207Q00000X Family Medicine (Licence: OH 35083971) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-10-27 |