| NPI | 1568874816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS018115) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2020-06-23 |