| NPI | 1750367249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.008053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0536130) |
| 207Q00000X Family Medicine (Licence: HI DOS-1307) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2021-04-06 |