| NPI | 1639170509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35096568) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.096568) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2025-06-24 |