| NPI | 1235138181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.075311CTR) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301075206) |
| 207Q00000X Family Medicine (Licence: NC 2014-00867) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-08-27 |