| NPI | 1619741527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 50.008580RX) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 50.008580RX) |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2024-01-29 |