| NPI | 1427405497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.015728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 292574) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2022-06-01 |