| NPI | 1093799744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.079152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 79152) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2021-08-17 |