| NPI | 1700803699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.008258) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 34.008258) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-10-26 |