| NPI | 1386831253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35092741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-092741) |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2016-06-09 |