| NPI | 1588643118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.037521) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: OH 35.037521) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2018-07-02 |