| NPI | 1023085834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.005767) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-05-5767) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2023-11-14 |