| NPI | 1629078860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34007141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 200599) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2016-02-24 |