| NPI | 1336377803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.124534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196061) |
| 207Q00000X Family Medicine (Licence: PA MD444333) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2018-09-20 |