| NPI | 1760598965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34004653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34004653) |
| 208D00000X General Practice (Licence: OH 34004653) | |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 34004653) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2025-09-09 |