| NPI | 1457419582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.083922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 287241) |
| 207Q00000X Family Medicine (Licence: OH OH35083922P) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2024-11-07 |