| NPI | 1982663043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 1706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 1706) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: OH 1706) | |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2019-07-18 |