| NPI | 1063734382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02006982A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34014015) |
| 207Q00000X Family Medicine (Licence: NY 279514) | |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2022-10-10 |