| NPI | 1669892659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.130120) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35130120) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2024-01-10 |