| NPI | 1215939954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01085774A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-05-3793) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2022-10-14 |