| NPI | 1750607388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 13083) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 34-011306) |
| 207Q00000X Family Medicine (Licence: OH 34011306) | |
| 207QA0401X Family Medicine Addiction Medicine (Licence: OH 34011306) | |
| 208D00000X General Practice (Licence: OH 34011306) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2025-06-12 |