| 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 |