| NPI | 1013993278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-086502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K2147) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-04-16 |