| NPI | 1609126705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35-01662) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-016622) |
| Enumeration Date | 2012-09-16 |
| Last Update Date | 2012-09-16 |