| NPI | 1568780591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-00478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.010723) |
| 207P00000X Emergency Medicine (Licence: NC 199090) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2023-06-14 |