| NPI | 1619957487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-100108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35100108) |
| 208D00000X General Practice (Licence: OH 35100108) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2010-12-30 |