| NPI | 1770560724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: OH 35.091967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36082109) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2024-04-09 |