NPI | 1164400370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.002376) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 002376) |
Enumeration Date | 2006-01-06 |
Last Update Date | 2017-10-12 |