| NPI | 1972711943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: MD D72958) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57011039) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-02-04 |