| NPI | 1629164728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.011107) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003466A) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2013-10-15 |