| NPI | 1023003258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35C.003063) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2025-10-22 |