| NPI | 1790785152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 69133) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 69133) |
| 207Q00000X Family Medicine (Licence: OH 69133) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2016-04-12 |