| NPI | 1235193194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.082328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35082328H) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2021-12-15 |