| NPI | 1912047994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 35.048348) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 35.048348) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-06-17 |