| NPI | 1811961006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-047010) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OH 35-047010) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2011-11-22 |