| NPI | 1144282880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.084595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 319778) |
| 207Q00000X Family Medicine (Licence: OH 84595) | |
| 207Q00000X Family Medicine (Licence: TX M4897) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2023-01-19 |