| NPI | 1184901803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.131767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.019935) |
| 207Q00000X Family Medicine (Licence: IN 01073443A) | |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2023-10-26 |