| NPI | 1942390794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35048646) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA02890500) |
| 207Q00000X Family Medicine (Licence: WV 13410) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2008-11-10 |