| NPI | 1366547382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.005908) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34 . 005908) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-07-13 |