| NPI | 1568422111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.146077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301047163) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 4301047163) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2022-07-12 |