| NPI | 1437136280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35035940P) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 13016) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2007-07-08 |