| NPI | 1184617888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 043264) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 043264) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-12-20 |