| NPI | 1598747537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-008750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002311a) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-12-03 |