| NPI | 1730171984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35051875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.051875) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-07-16 |