| NPI | 1407844749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35048739S) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35048739S) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2020-04-28 |