| NPI | 1144660507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013032) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34.013032) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-08-17 |