| NPI | 1649286360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 83450) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 83450) |
| 207P00000X Emergency Medicine (Licence: OH 35.083450CTR) | |
| 207R00000X Internal Medicine (Licence: OH 35.083450CTR) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-08-03 |