| NPI | 1215918446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34007612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007612R) |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2012-02-09 |