| NPI | 1851508246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.009151) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.009151) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-06-14 |