| NPI | 1588700017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 89168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.089168) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-10-10 |