| NPI | 1427495092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35128152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q1445) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2023-11-03 |