| NPI | 1982867602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.012884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A110016) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2010-10-04 |