| NPI | 1487922241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.132816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209091) |
| 208600000X Surgery (Licence: OH 57.019955) | |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2018-08-30 |