| NPI | 1093791212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-0076065) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35076065) |
| 207P00000X Emergency Medicine (Licence: OH BE4044736) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-05-30 |