| NPI | 1558799627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.012125) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58005250) |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2016-09-30 |