| NPI | 1417948076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD52553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35053974M) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2022-03-29 |