| NPI | 1811420342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 339472-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.139173) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-09-09 |