| NPI | 1003815689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.081549CTR) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35081549) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2023-05-10 |