| NPI | 1386699940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35049885) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 35049885) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2019-05-17 |