| NPI | 1174769186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35-093533) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-093533) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2025-07-23 |