| NPI | 1912907890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.005306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS8851) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-10-27 |