| NPI | 1932487790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2011012590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-06-5652) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2011-07-28 |