| NPI | 1427310473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.010598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004026A) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-04-04 |