| NPI | 1689740573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34. 011057) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2455) |
| 207R00000X Internal Medicine (Licence: OH 34. 011057) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2014-06-25 |