| NPI | 1164259743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: OH 0000000000) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: OH 00000000) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |