| NPI | 1932228129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35094424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35094424) |
| 208600000X Surgery (Licence: OH 35094424) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2019-10-31 |