| NPI | 1730426958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01075150A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57018474) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2015-10-15 |