| NPI | 1013270230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 293490) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.132418) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-07-16 |