| NPI | 1326452061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 55283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 55717) |
| 207Q00000X Family Medicine (Licence: OH 35.143085) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2024-12-09 |