| NPI | 1689835431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.124547) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 262545) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-02-20 |