| NPI | 1730140203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-06-7037) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35067037) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-10-20 |