| NPI | 1578530127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35062845) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.062845) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2021-03-18 |