| NPI | 1407964315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: OH 35-074032) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: OH 35074032) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-12-31 |