| NPI | 1962665737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 249373) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.096829) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2015-11-30 |