| NPI | 1982691994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-3533) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2008-01-31 |