| NPI | 1073500039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35-044048) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35 044048N) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2012-11-28 |