| NPI | 1861468597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.005798) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34-005798) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-11-13 |