| NPI | 1578563128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: OH 34-00-2116G) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34-00-2116G) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2011-08-16 |