| NPI | 1699831198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 71770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.128183) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2024-08-23 |