| NPI | 1932141132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35.088805) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301058801) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-09-21 |