| NPI | 1417921057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35055812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35055812B) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2018-02-23 |