| NPI | 1154841922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.139019) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.029851) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2021-10-27 |