| NPI | 1750517397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-098149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 308968) |
| 207Q00000X Family Medicine (Licence: OH 57.015985) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2021-03-11 |