| NPI | 1003107558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.120353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8859872-1205) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2023-05-09 |