| NPI | 1467443580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-005018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34005018C) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2014-10-09 |