| NPI | 1154342582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-004529) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 34.004529) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2025-08-04 |