| NPI | 1780661074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02002139A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34006949W) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2026-06-03 |