| NPI | 1205893179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35073231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35073231L) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-01-18 |