| NPI | 1700885340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: PA MD453345) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 35067781S) |
| Enumeration Date | 2005-07-16 |
| Last Update Date | 2016-09-21 |