| NPI | 1952365686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35077370S) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2016-08-25 |