| NPI | 1700878329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-00-4194-S) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003471A) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2020-11-18 |