| NPI | 1477549962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: SC MD88243) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 01035849) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35045593) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-07-08 |