| NPI | 1215149455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35089564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-048828) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-12-27 |