| NPI | 1154826683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01085040A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.137484) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2025-10-09 |