| NPI | 1306908132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.129685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01070166 A) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2024-03-18 |