| NPI | 1619970704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.044870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01038230A) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2024-09-13 |