| NPI | 1902867351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CT 82823) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-050840) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2025-08-31 |