| NPI | 1730539685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016962) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2026-03-23 |