| NPI | 1750392676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003311A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.009629) |
| 207Q00000X Family Medicine (Licence: FL OS16751) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-04-01 |