| NPI | 1548259617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102209331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-7985) |
| 207Q00000X Family Medicine (Licence: PA OS016525) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2025-08-08 |