| NPI | 1124294988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-097985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT191226) |
| 207Q00000X Family Medicine (Licence: PA MD439566) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2016-04-14 |