| NPI | 1245220912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OH 35050063) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35050063) |
| 208D00000X General Practice (Licence: OH 35050063) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2026-02-09 |