| NPI | 1508082447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 34.009260) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.009260) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OH 34.009260) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2024-04-16 |