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 |