| NPI | 1386629475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-4900-P) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2022-07-21 |