| NPI | 1386631141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35080366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-080366) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2024-04-08 |