| NPI | 1902246580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.012108) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2019-01-04 |