| NPI | 1831273911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 204206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.089273) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-02-11 |