| NPI | 1912139072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35096903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35096903) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: OH 35.096903) | |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2023-05-17 |