| NPI | 1346233426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 55172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 18469) |
| 207Q00000X Family Medicine (Licence: OH 35080919R) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2022-02-01 |