| NPI | 1801182738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.075586) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.075586) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2013-04-25 |