| NPI | 1316991003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS14963) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OS014963) |
| 207Q00000X Family Medicine (Licence: OH 34.009399) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-12-06 |