| NPI | 1083655641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35.047626) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35047626K) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-03-17 |