| NPI | 1720573066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021062) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.017200) |
| 207P00000X Emergency Medicine (Licence: OH 34.017200) | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-10-15 |