NPI | 1679530307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35044161) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35044161K) |
Enumeration Date | 2006-04-27 |
Last Update Date | 2019-12-02 |