| NPI | 1225392053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q6001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.125355) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2025-07-31 |