| NPI | 1912950031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WV 20059) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 20059) |
| 207P00000X Emergency Medicine (Licence: OH 35.078622) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.078622) | |
| 207R00000X Internal Medicine (Licence: WV 20059) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-09-06 |