| NPI | 1407177835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.140839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL32889) |
| 207Q00000X Family Medicine (Licence: TN 50380) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2023-11-20 |