| NPI | 1760566863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35-036772) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-036772) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-08-12 |