| NPI | 1568478626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35054820) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: OH 35054820P) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-04-18 |