| NPI | 1275525032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.093342) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 298341) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2023-07-03 |