| NPI | 1285802314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35058959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-058959) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2022-05-02 |