| NPI | 1689630329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35047888) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35047888) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OH 35047888) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2017-08-13 |