| NPI | 1962710582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 390200000x) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.121074) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2018-04-20 |