| NPI | 1285669481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.048254) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-048254) |
| 207V00000X Obstetrics & Gynecology (Licence: OH 35048254) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-12-26 |