| NPI | 1932102985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-037876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD011535) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-12-24 |