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 |