| NPI | 1063527489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.063603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35063603D) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2023-02-23 |