| NPI | 1194947648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01065753A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.092012) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2017-02-23 |