| NPI | 1053707893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35144082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 300918) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2026-03-10 |