| NPI | 1023080116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35063468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01038529) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2019-03-01 |