| NPI | 1629055165 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.048001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35048001) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2012-08-01 |