| NPI | 1811992613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 34004454) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS-006357L) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2022-07-21 |