| NPI | 1629053681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.080641) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35. 080641) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-08-29 |