| NPI | 1235370461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 276924-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-0037799) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2022-02-23 |