| NPI | 1669887535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 57.030151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206391) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2017-07-09 |