| NPI | 1780999201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09987700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.121202) |
| 208M00000X Hospitalist (Licence: OH 35.121202) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2021-05-25 |