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 |