| NPI | 1336460823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 272706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.155516) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2026-06-30 |