| NPI | 1558464883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 35045653) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35045653) |
| 208000000X Pediatrics (Licence: OH 35045653) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2008-08-05 |