| NPI | 1477769032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.009148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58-02259) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-08-29 |