| NPI | 1235131848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.057127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.057127) |
| 207Q00000X Family Medicine (Licence: WV 12479) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2021-01-21 |