| NPI | 1477802031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.021214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME121928) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2015-05-14 |