| NPI | 1013351477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 295278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.127937) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NY 295278) | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2024-01-25 |