| NPI | 1558780247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.134577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 289957-1) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2018-09-04 |