| NPI | 1245289529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35133415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 12294) |
| 207P00000X Emergency Medicine (Licence: SC 12294) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2018-06-07 |