| NPI | 1437686037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX W3625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34014829) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2026-05-07 |