| NPI | 1255777397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101020457) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH BM9528324C166) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2021-02-24 |