| NPI | 1184738619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-088000) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 35088000) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2021-01-14 |