| NPI | 1114903721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35045924M) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35045924M) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35045924M) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2021-04-30 |