| NPI | 1942203377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-063130) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.063130) |
| 208000000X Pediatrics (Licence: OH 35-063130) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2024-09-24 |