| NPI | 1578556890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34005838) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.005838) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2024-08-05 |