| NPI | 1962435073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 34007192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-7192H) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2012-01-06 |