| NPI | 1871661645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC TL1223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-003256) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-08-09 |