| NPI | 1922114503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34004043) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-11-19 |