| NPI | 1588045116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO3433) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 012648) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2018-06-25 |