| NPI | 1104821206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35040954) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35040954C) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2026-04-16 |