| NPI | 1245233345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.079906) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 36991) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2026-03-16 |