| NPI | 1073714812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.093747) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY 43226) |
| 207P00000X Emergency Medicine (Licence: OH 35093747) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2021-03-05 |