| NPI | 1184838831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 249267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57010945) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2009-05-13 |