| NPI | 1548243900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 34-008570) |
| Additional Taxonomies | 251S00000X (Licence: OH 34-008570) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2021-07-19 |