| NPI | 1194018093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014126) |
| 207Q00000X Family Medicine (Licence: OH 34.015525) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2023-05-24 |