| NPI | 1699716209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35043639S) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35043639S) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2008-06-25 |