| NPI | 1972946903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.011999) |
| Additional Taxonomies | 246YC3302X Spec/Tech, Health Info, Coding Specialist, Physician Office Based (Licence: OH 34.011999) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2021-02-04 |