| NPI | 1801201348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.011935) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R1708) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-01-03 |