| NPI | 1073628533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35-066429) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.066429CTR) |
| 208D00000X General Practice (Licence: CA G89337) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-12-02 |