| NPI | 1528447158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.134725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018089A) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2018-08-13 |