| NPI | 1629045661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD041729E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35063295) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-11-19 |