| NPI | 1982768255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.052270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 52270) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2022-01-03 |