| NPI | 1750312062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02000625A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.002611) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-06-07 |