| NPI | 1366882839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.140455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 56466) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: CT 56466) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2022-12-19 |