| NPI | 1508845207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: OH 35-069734) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-069734) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2008-12-05 |