| NPI | 1609846070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34001383M) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OH 34001383M) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2009-10-22 |