| NPI | 1164963435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S4308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.014115) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2025-12-18 |