| NPI | 1033435789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35120902) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35 120902) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2026-09-03 |