| NPI | 1396953956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.094647) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.094647) |
| 208M00000X Hospitalist (Licence: OH 35.094647) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-03-12 |