| NPI | 1174555296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.088417) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.200839) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35088417) | |
| 282N00000X General Acute Care Hospital (Licence: OH 35088417) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-04-24 |