| NPI | 1023078532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.004278) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 34-004278) |
| 207Q00000X Family Medicine (Licence: OH 34-004278) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2020-02-11 |