| NPI | 1609872860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35050367) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 19102) |
| 207P00000X Emergency Medicine (Licence: OH 35050367) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-05-12 |