| NPI | 1184729220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-056978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01036887A) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-02-08 |