| NPI | 1821262544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-028113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35. 028113) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2013-04-26 |