| NPI | 1063514784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH AK35046206) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-04-6206) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2024-01-19 |