| NPI | 1417933490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 34.004690) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 34.004690) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2023-08-04 |