| NPI | 1457458648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: OH 35-075697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35075697R) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-09-21 |