| NPI | 1053487108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35049219) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01040231) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2017-02-01 |