| NPI | 1790770568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35083481N) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35083481) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2018-03-17 |