| NPI | 1528061678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.084889) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35084889) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2013-11-15 |