| NPI | 1801135892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-037222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-037222) |
| 208600000X Surgery (Licence: OH 35-037222) | |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2013-02-11 |