| NPI | 1134411069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 011294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014001) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2020-03-24 |