| NPI | 1841604071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35C.000635) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 37171) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2024-03-14 |