| NPI | 1285945311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS022110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.011238) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2023-05-18 |