| NPI | 1336513217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.046211) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: OH 046211) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2021-03-16 |