| NPI | 1689022253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.143133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT211383) |
| 207Q00000X Family Medicine (Licence: MI 4301500515) | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2022-01-14 |