| NPI | 1346373446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.003690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34003690W) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-09-26 |