| NPI | 1821075730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.088367) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: OH 35-88367) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2014-05-22 |