| NPI | 1780941724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P8453) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2019-06-12 |