NPI | 1003233263 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01076363A) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35131332) |
Enumeration Date | 2014-03-26 |
Last Update Date | 2020-07-29 |