| NPI | 1114071776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P5468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35087911) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-12-14 |