| NPI | 1417974056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-037562) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-03-7562-J) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-08-17 |