| NPI | 1265503700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.095587) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM 804) |
| 208600000X Surgery (Licence: OH 35-095587) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.095587) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2013-08-08 |