NPI | 1922092519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: OH 35.037240) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35037240) |
Enumeration Date | 2005-09-09 |
Last Update Date | 2024-05-04 |