| NPI | 1538276472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 90339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 231575) |
| 207Q00000X Family Medicine (Licence: MD D0066659) | |
| 207Q00000X Family Medicine (Licence: VA 0101241476) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-10-30 |