| NPI | 1780798892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD453611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35077465D) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2018-12-19 |