| NPI | 1912360348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.015620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005741A) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2022-08-19 |