| NPI | 1922058965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34-00535) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34005535T) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-11-17 |