| NPI | 1780371062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.154883) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.154883) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2026-08-27 |