| NPI | 1497733422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35033390D) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35033390D) |
| 208000000X Pediatrics (Licence: OH 35033390D) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2023-03-07 |