| NPI | 1922319623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.010836) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2023-02-06 |