| NPI | 1568877546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.012817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017965A) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2024-02-12 |