| NPI | 1124000781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35085021) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 246840-1) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2022-01-25 |