| NPI | 1598736472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.139023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01081132A) |
| 207Q00000X Family Medicine (Licence: NY 230369) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-05-13 |