| NPI | 1710983622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-06-6562-C) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01040465A) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2026-05-13 |