| NPI | 1851331706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-06-6089-K) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.066089) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-03-17 |