| NPI | 1619965472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35053076D) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35053076D) |
| 208D00000X General Practice (Licence: OH 35053076D) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2011-06-08 |