| NPI | 1447526983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.011131) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 34.011131) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2022-01-03 |