| NPI | 1063499598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35055967A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35055967A) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2018-05-17 |