| NPI | 1972582799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.064418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35064418S) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2009-01-28 |