| NPI | 1073570958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 45561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35040680E) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: KY 45561) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 40680) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-11-18 |